Obama administration officials, racing to beat a month-end deadline to fix the troubled federal insurance website, said Sunday there has been "dramatic progress" in patching HealthCare.gov but acknowledged "there is more work to be done" in improving the site and its underlying technology.

An eight-page report released Sunday morning by Centers for Medicare and Medicaid Services officials offered a few details of progress in fixing the site, which crashed shortly after its launch Oct. 1.

Among the areas of progress: The site now allows 50,000 people to use it simultaneously – which the administration says was the intended goal.

Jeffrey Zients, the Obama aide tasked with fixing the technical mess, told reporters in a call that HealthCare.gov now has enough firepower to handle its "intended volume." He said the site today "is night and day from where it was on Oct. 1."

Still, the administration expects volume spikes in December because of previous delays accessing the site and will likely be unable to cope with that level of demand. Zients said a wait-list system has been implemented for when the site can't keep up with user demand and it will send an email to users when it is again available.

The administration also said wait times for Internet pages to load had improved, dropping from eight seconds to less than one. More than 400 fixes have been made to the site.

Enrollment in new health plans has increased since October, when just 106,185 Americans signed up. But the website problems and delayed marketing plans could make it difficult for administration officials to meet their goal of seven million people enrolled in private health plans by the end of March.

Contractors and outside engineers from Google Inc and Oracle Corp. brought in by Obama administration officials have been working overtime over the past five weeks to try to fix the site and its underlying technology, including systems that send information and payments to insurers.

Administration officials say they installed fixes this weekend to address erroneous customer data that have been sent to insurers. They won't know if that issue has been fixed until more consumers get through the enrollment process and more customer data are sent to insurers, said Julie Bataille, a Centers for Medicare and Medicaid Services spokeswoman.

By Saturday evening, technicians completed a major hardware upgrade, adding computing, storage and database capacity to their data center, said one person familiar with the situation. "There was a big install and it worked," the person said.

Contractors believe the upgrades will improve the system's performance and let it handle more visitors. In the coming days, the goal is to try to stabilize HealthCare.gov following the latest upgrade, and make sure that it can handle the higher volume of visitors expected in December, the person said.

Much of the repair effort leading up to the final week has focused on making the site look and work better, and officials reported progress in tasks such as making pages load faster.

But big technical problems still affect HealthCare.gov's ability to verify users' identities and transmit accurate enrollment data to insurers, officials say. The data center that supports the site continues to face challenges, and tools for processing payments to insurers haven't been built.

The success of the White House's signature domestic initiative is riding on the technicians' ability to fix the site, as well as the rest of the federal technology supporting enrollment. Across the nation, that effort was being eyed hopefully by supporters of the law, since the site is the centerpiece of the effort to overhaul American health care and extend coverage to millions of people.

One source of early problems was that the government had bought web-hosting services from Verizon Communications Inc. subsidiary Terremark that initially gave it a highly virtualized system of servers shared by other groups within the Medicare center, rather than a dedicated group of computer servers for HealthCare.gov that could have enabled speedier changes to the site.

Health and Human Services also didn't initially contract for a backup website or monitoring tools like those used by sophisticated consumer sites, according to people familiar with the matter. The website still has no separate backup copy, but it did replace the virtual database with dedicated hardware, and bought and installed monitoring software used by many Internet companies.

The main trade group for the industry, America's Health Insurance Plans, issued a statement Saturday saying that the enrollment data issue was among several "significant issues that still need to be addressed."

Linking genes to diseases by sifting through Electronic Medical Records

The days of scrawled doctor’s notes are slowly coming to a close. In the United States, 93 percent of hospitals are now using at least some electronic medical records and 2.2 percent have given up paper records completely, according to the consulting firm HIMSS Analytics.

The federal government has been pushing for electronic medical records for a decade, arguing that they will improve health care and bring down costs. That is still a matter of debate. Critics charge that the system is hobbled by poorly designed software and that some hospitals are using electronic medical records to bill more for the same services.

But a new study suggests that electronic medical records may have another, entirely different use: as a Rosetta Stone for our DNA. Researchers are using them to trace links between genes and disease.

To run such a study, scientists find a lot of people with the same condition — diabetes, for example, or Alzheimer’s disease. Then they take samples of DNA from the subjects and search them for mutations that are unusually common in people with the disease compared with people without it.

A study published this week in Nature Biotechnology opens up a new way to search for these links: by turning genome-wide associations on their head. In the new approach – called phenome-wide association studies – scientists start with a gene variant and then search among thousands of conditions for a match.

To find those matches, scientists comb through electronic medical records.

The new study was carried out by scientists from a consortium of medical research institutions. Known as the Electronic Medical Records and Genomics Network – eMERGE for short – it was founded in 2007 and includes institutions like the Mayo Clinic and Vanderbilt University School of Medicine.

The eMERGE network has developed software to extract and analyze information from their electronic medical records. Those records rarely include genetic information, but the researchers have also been setting aside blood samples from patients for genetic studies. After making the two sets of information anonymous, the researchers combined them into a single database.

The eMERGE team has now taken the database out for a test run. Looking at previously published genome-wide association studies, they identified 77 gene variants with strongly supported links to diseases. The scientists then tried to replicate the results.

To do so, they started with the gene variants and looked through the electronic medical records of their patients for any unusually common conditions. “We have everything they come to the doctor for,” said Dr. Joshua C. Denny, a biomedical informatics researcher at the Vanderbilt University School of Medicine and a co-author of the new study.

In 51 out of 77 cases, Dr. Denny and his colleagues ended up with the same link. With 1,358 different conditions to choose from in the electronic medical records, it was practically impossible for them to do so well simply by chance.

The eMERGE team then searched for new links of their own. They surveyed 3,144 gene variants identified in past genome-wide association studies to see if they also influenced any other diseases. They discovered 63 new links to diseases, ranging from skin cancer to anemia.

This finding also has exciting potential. Scientists have long known that a single gene can have a variety of effects on our health. That is because genes are biological multitaskers, helping carry out different functions in the body.

The eMERGE database now has information on about 51,000 patients and the researchers are currently expanding their phenome-wide association studies accordingly. Daniel MacArthur, a geneticist at Massachusetts General Hospital who was not involved in the new study, predicted that larger databases of electronic health records will allow scientists to find links between diseases and rare gene variants that are so far impossible to detect. “This is exciting stuff,” he said.

Even larger studies are on the horizon. The Department of Veterans Affairs, for example, has set up the Million Veteran Program, which will combine electronic medical records and a DNA database from volunteers. They now have 240,000 veterans enrolled.

“Unfortunately,” said Dr. MacArthur, “applying this on a larger scale in the U.S. is complicated by the dire state of electronic medical records.”

Sunquest is requesting support of the HIT community to encourage the FDA’s drive to regulate HIT. There are increasing indications that the FDA intends to regulate Health Information Technology. Sunquest is in strong support of this movement, as regulation of HIT will help ensure Patient Safety is a first and utmost requirement.

Stated simply, innovation is the key to continued progress in our industry; and FDA regulation should be seen as a tool to foster safety-inducing innovation.

Reasonable and effective FDA regulation of a high-tech, growing industry like HIT, will foster further innovative progress that we are all counting on to help reform the healthcare system. This reform shall be based on a sound, accountable basis resulting in measurable and improved Patient outcomes.

Sunquest is forming “The HIT Group” which will be comprised of members united to encourage the FDA to regulate HIT. Together, the group will work to influence regulatory approaches through letters and communication with HHS and all applicable Government agencies and Offices. They will also share progress on regulation through webinars, share best practices, and unite in their mission to encourage the FDA to regulate HIT.

Please consider adding your company to the list of industry stakeholders and becoming a part of “The HIT Group.” To do so, please email Patrice JC Nedelec, Vice President of Client Experience (Quality-Regulatory-Validation- Support) or Anne Delaney, EJD, Director QARA at FosterHITProgress@sunquestinfo.com.

The Centers for Medicare and Medicaid Services (CMS) released two final regulations of note to cardiovascular professionals. These rules determine the payment levels and associated policies for services provided under the Physician Fee Schedule and the Hospital Outpatient Prospective Payment System.

Overall, the rules indicate a 1.7 percent increase in payment for hospital outpatient services and a 20 percent decrease in physician fee schedule services. The large overall decrease in physician payments is associated with the long-standing Sustainable Growth Rate (SGR) formula. The ACC continues to urge Congress to permanently address this issue. See more on that issue here. Changes unrelated to the SGR result in a 1 percent increase for services provided by cardiologists.

In addition to the overall payment changes, there are a number of provisions of particular importance for cardiovascular professionals, including the following:

* Payments for many common services provided in the outpatient setting will be packaged into office visits also provided in the hospital setting as well as packaged into other major hospital services. This includes all laboratory services.

* Payments for the technical components of SPECT and echocardiography services in the hospital will increase and payments for many CT and MR services will decrease due to technical changes associated with how costs are categorized in the hospital system. Payments for the physician interpretation will not substantially change.

* CMS had proposed that payments for device-intensive cardiovascular services, such as PCI and ICD placement, be paid on a bundled basis referred to as a “comprehensive APC” that is similar to the DRG payment system used for inpatient services, rather than being paid for each individual APC code. CMS finalized this proposal but delayed the implementation date to 2015.

* CMS deferred a proposal to cap practice expense payments for services provided in the office so that the total payment would not exceed the amount Medicare would pay for the same service in the hospital. This change would have cut the payment for a number of lower extremity revascularization services by an average of 40 percent.

* Physician groups of 10 or more providers (includes MD/DO, PA, NP) will have their payment adjusted under the value-based modifier in 2016. The payment adjustments will be based on cost and quality data for patients seen during 2014.

* Physicians will have expanded opportunities to use registries to participate in the Physician Quality Reporting System (PQRS) program. Expect more from the ACC’s National Cardiovascular Data Registry (NCDR) regarding opportunities for this in coming months.

At the Radiological Society of North America (RSNA) Annual Meeting on December 1-6, in Chicago, IL, RSNA President Sarah S. Donaldson, M.D., knows how demanding it is to practice medicine these days, with calls to make medicine ever more accurate, safe and effective. However, she said, all physicians – and radiologists in particular – must still find time to form and nurture partnerships with one another.

"If radiologists want to participate in the practice of medicine today, we must participate in multidisciplinary teams and accept responsibility for patient care," said Dr. Donaldson, who opened RSNA 2013 with her President's Address, "The Power of Partnership" presented Sunday. Dr. Donaldson is the Catharine and Howard Avery Professor of Radiation Oncology at Stanford University School of Medicine in Stanford, Calif. She also serves as the associate director of the radiation oncology residency program at Stanford Hospital and Clinics and is chief of the radiation oncology service at Lucile Salter Packard Children's Hospital at Stanford.

Dr. Donaldson used the example of tumor boards and conferences, where other medical specialties are routinely represented but radiology may not consistently be in attendance. "While radiologists may feel they can't free up personnel to participate in every clinic, conference, and tumor board, they must do so. To succeed in today's health care environment, we must be part of the team." Traditional expectations, attitudes and behaviors, as well as technological innovations, all have influenced the isolation of radiologists from other healthcare providers, Dr. Donaldson said, but to resist this isolation and embrace team-based medicine promotes collaborative research programs, augments one's expertise and builds careers. "Professional interdependence promotes innovation and adds value to our collective endeavors," Dr. Donaldson said.

While increased partnerships are possible with a spectrum of stakeholders in industry, government, education, research and certification, the most important focus of teamwork is patient care, Dr. Donaldson said. "The physician/patient bond that is well-developed in oncology, serves as a model for all of radiology," she said.

The pressures to make medicine safer and more effective and efficient are very real, not only in the U.S. but around the globe, Dr. Donaldson said, but these challenges are also opportunities for discovery. "It is important to be positive," she said. "Even though it may be tough, it is ever so gratifying."

Toshiba’s Aquilion ONE ViSION Edition, ONE and Premium CT customers to share best practices, key learnings

Providing Aquilion ONE ViSION Edition, Aquilion ONE and Aquilion Premium customers with the opportunity to share best practices in CT imaging, Toshiba America Medical Systems, Inc. announces the Aquilion ONE Club. The Aquilion ONE Club consists of in-person meetings and an online community, enabling clinicians to collaborate with other users.

Members of the Aquilion ONE Club have access to an online forum on CT imaging, information on the latest protocols, online trainings for new software, clinical images, marketing materials and PowerPoint presentations.

Merge Healthcare Incorporated, a provider of clinical systems and innovations that seek to transform healthcare, is showcasing their new universal viewer solution at RSNA. An industry first, iConnect Access Version 5.0 smartly combines enterprise viewing with image sharing for easy image review for referring physicians anywhere, any time.

Because patients are cared for in multiple locations, iConnect Access addresses the need for a clinical collaboration solution that enables patients' images to follow them to the point of care. Merge's solution combines a zero-client enterprise universal viewer with an image sharing/CD import workflow manager and a non-DICOM management tool that integrates seamlessly into EHR workflow. This single, integrated solution aligns with an organization's strategic goals, enhances performance, and is easy-to-use by all stakeholders.

Slated for delivery in the first quarter of 2014, iConnect Access 5.0 is part of the iConnect Enterprise Clinical Platformand includes iConnect Enterprise Archive, which was ranked the largest vendor-neutral archive in the world for the second year in a row by IHS. To learn more about iConnect Access, visit Merge's booth #2529 at the RSNA Annual Meeting for a demo.

Samsung Electronics America Inc., a subsidiary of Samsung Electronics Co., Ltd, is showcasing its growing presence in the radiology field and its commitment to deliver a new healthcare experience through accurate, easy and fast diagnostics solutions at the RSNA. Product specialists will be on hand all week at booth #6913 (North Building) demonstrating Samsung’s full range of solutions including Ultrasound, Digital Radiography (DR) and portable Computed Tomography (CT) systems.

The changing healthcare landscape will challenge healthcare providers to find more efficient and cost-effective clinical pathways to deliver diagnosis and transform the care they offer to patients
For the first time in the Samsung booth, subsidiary NeuroLogica will be showcasing its lineup of portable Computed Tomography solutions. From the 32-slice BodyTom to the small bore CereTom and inSPira HD SPECT, NeuroLogica’s mobile solutions bring CT imaging to the patient, whether they be in intensive care, the operating room, emergency department or other key clinical areas.

Now commercially available in the U.S., Samsung is also demonstrating its lineup of Samsung XGEO Digital Radiography systems which combine advanced imaging technology, award-winning design and user-friendly automated workflows to meet the demands of 21st century radiology departments. In 2014, Samsung is also introducing a new detector that will provide enhanced image quality in low dose conditions by direct deposition technology for the Samsung XGEO GC80 and XGEO GU60A as well as other new DR systems.

Investment in the healthcare industry is an important part of Samsung’s 2020 global growth vision. The 2012 launch of Samsung Electronics America’s Health and Medical Equipment business, which unified Samsung Medison America’s personnel within the Enterprise Business Division, and this year’s acquisition of leading mobile CT provider NeuroLogica provide key capabilities and create a unified structure for Samsung on the path to becoming a trusted leader in the healthcare industry.

At the 99th Scientific Assembly and annual meeting RSNA, Siemens Healthcare (Booth #1934, South Building/Lakeside Center at McCormick Place, Hall A) will provide “Answers for Life” by offering cutting-edge and accessible technological innovations designed to advance human health. With these systems and related solutions, Siemens will demonstrate its enduring status as a trusted partner that helps its customers fight the world’s most threatening diseases, elevate quality and productivity in health care, and enable improved access to treatment.

At RSNA 2013, Siemens will showcase the following innovations:

The visionary Artis Q and Artis Q.zen angiography systems from Siemens feature a revolutionary X-ray tube and detector technology designed to improve minimally invasive therapy for coronary artery disease (CAD), stroke and cancer, helping hospitals improve patient outcomes and satisfaction. Paired with CARE+CLEAR, a comprehensive portfolio of image quality and dose-saving tools that is standard with all Artis systems, Siemens is determined to provide the lowest possible dose to its customers.

Engineered to drive efficiency and reduce costs, the new 16- and 32-slice configurations of Siemens’ SOMATOM Perspective family of computed tomography (CT) scanners1 bring high-end technologies to a broader clientele, with the option of upgrading to the established 64- and 128-slice configurations. In addition to being suitable for routine oncology scans as well as head, neck, lung, and abdominal imaging, the 16-slice SOMATOM Perspective can help ensure that pain-relieving analgesics are delivered to the correct location during surgery. The 32-slice configuration is designed to provide more detailed imaging for bone fractures, inner ear examinations, and vascular applications.

Siemens will debut technologies designed to enable fast body magnetic resonance (MR) imaging for all patients. The technologies will be available on the MAGNETOM Skyra 3T and MAGNETOM Area 1.5T MRI systems. The new StarVIBE MR pulse sequence is designed to enable free-breathing, contrast-enhanced liver imaging for patients (including patients who are old, very ill, or young) unable to easily manage breath-holding. Siemens’ new TWIST-VIBE MR sequence is designed to enable correct contrast imaging in dynamic liver MRI for all patients and lesions, allowing fast, robust liver imaging with full 4D coverage. The sequences StarVIBE and TWIST-VIBE will be available as the FREEZEit package.

Also at this year’s RSNA, Siemens will introduce its Quiet Suite of applications, which covers complete, quiet neuro and musculoskeletal MR examinations with a minimum 70 percent reduction in sound pressure and no compromise in image quality. Optimized to make MRI more comfortable for patients and to improve the comfort of sensitive patients such as children and the elderly, Quiet Suite will be available with the MAGNETOM Skyra 3T and MAGNETOM Area 1.5T MRI systems.

You have options when it comes to data warehouses – but which one is right for your healthcare organization? Discover the difference of the late-binding data warehouse architecture. And see why this unique system offers quick time-to-value and the agility necessary to meet the changing demands of the healthcare industry.

Learn what you need to know in a world measured by value-based care. Attend the hour-long webinar titled "A Road Map to Success Under the New Reimbursement Model." Bobbi Brown, vice president of financial engagement at Health Catalyst, discusses the new era of accountability for providers, including a review of the metrics defined by CMS for value-based purchasing and lessons learned from other hospitals.